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NPI Code Detail

MEDICARE: SOUTH GEORGIA MEDICAL CENTER INC

MEDICARE: SOUTH GEORGIA MEDICAL CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy008065GA
23336S0011XSpecialty Pharmacy
33336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2008065OTHERGASTATE LICENSE NUMBER
31143510OTHERGANCPDP NUMBER

General Provider Information

NPI Number : 1528049046
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH GEORGIA MEDICAL CENTER INC
Provider Business Mailing Address
First Line : PO BOX 1805
Second Line :
City : VALDOSTA
State : GA
Zip : 31603-1805
Country : US
Telephone Number : 229-433-7150
Fax Number : 229-433-8416
Provider Business Practice Location Address
First Line : 2501 N PATTERSON ST
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-1735
Country : US
Telephone Number : 229-249-4144
Fax Number : 229-249-4145
Authorized Official
Title or Position : CONTROLLER
Name : JULIE W HODGES
Credential :
Telephone Number : 229-259-4140
Provider Enumeration Date : 11/10/2005
Last Update Date : 09/02/2025

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Directions to “SOUTH GEORGIA MEDICAL CENTER INC ” Practice Location

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